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目的 评价不同小剂量 [3,5 ,和 1 0 μg/ (kg·min) ]多巴酚丁胺二维超声心动图 (Dob 2DE)试验识别急性心肌梗死 (AMI)患者存活心肌的准确性和安全性 ,探讨Dob最小有效剂量。方法 AMI患者 31例 ,均于梗死后 7～ 1 4d行不同小剂量Dob 2DE试验 ,并成功接受了冠状动脉血运重建术 (CRV) ,术后约 6个月复查 2DE。将试验时检出存活心肌节段与CRV术后相应节段收缩改善的实际对比 ,计算识别存活心肌的准确性 ,评价其安全性。结果 31例AMI患者的 2 2 1个室壁运动异常节段中 ,三种剂量Dob[3,5 ,和 1 0 μg/(kg·min) ]2DE试验分别检出 40 .7%、5 0 .2 %和 5 5 .8%的存活心肌节段 ;识别存活心肌的敏感性分别为6 1 .6 %、78.4%和 89.4% ,阴性预测值及准确性分别为 6 3.4%、75 .5 %和 87.9%及 72 .4%、81 .9%和 86 .8% ,Dob 3μg/ (kg·min)时各值均显著降低 (P均 <0 .0 5 ,0 .0 0 1 ) ,而Dob 5和 1 0 μg间除敏感性外均无显著差异。Dob 3,5和 1 0 μg/ (kg·min)副作用发生率分别为 0、1 2 .9%和 2 9.0 % ,特别是Dob 1 0 μg/ (kg·min)时诱发心肌缺血 2例 (6 .9% )。结论 Dob 1 0 μg/ (kg·min) 2DE试验识别AMI存活心肌最准确 ,但欠安全 ;Dob 3μg/(kg·min) 最安全 ,但敏感性下降 ;Dob 5 μg/ (kg·min)准确
Objectives To evaluate the accuracy of doobucide two-dimensional echocardiography (Dob 2DE) at different low doses [3, 5, and 10 μg / (kg · min)] in identifying viable myocardium in patients with acute myocardial infarction Safety, to explore the Dob minimum effective dose. Methods Thirty-one AMI patients underwent Dob 2DE with different doses of Dob 2DE at 7 to 14 days after infarction and successfully received coronary revascularization (CRV). 2DE was performed at about 6 months after operation. The test was detected when the survival of myocardial segments and CRV after the corresponding segment contractions improved compared to calculate the accuracy of identification of viable myocardium to evaluate its safety. Results Among 31 patients with AMI, 21 patients were divided into two groups by 2DE (Dob [3,5] and 10 μg / (kg · min)] 2DE test, respectively, with 40.7% and 50% .2%, and 55.8% of surviving myocardial segments. The sensitivity of identifying viable myocardium was 61.6%, 78.4% and 89.4% respectively. The negative predictive value and accuracy were 6 3.4% and 75.5 respectively (P <0.05, 0.010) were significantly lower than those at Dob 3μg / (kg · min) at 87.9%, 72.9%, 81.9% and 86.8% There was no significant difference between Dob 5 and 10 μg except for sensitivity. The incidence of side effects of Dob at 3, 5 and 10 μg / (kg · min) were 0, 12.9% and 29.0% respectively, especially in Dob at 10 μg / (kg · min) (6.9%). Conclusion Dob at 10 μg / (kg · min) 2DE is the most accurate, but not safe method for identifying myocardial viable myocardium in AMI. Dob 3 μg / (kg · min) is the safest, but its sensitivity decreases. Dob 5 μg / (kg · min)